Reader Question: Modifier, Not Code, May Capture Take-Down

What is appropriate CPT®code for mobilization of splenic flexure in addition to laparoscopic transverse loop colostomy (we can't use +44213 because it is limited to use with 44204-44208)?

Ohio Subscriber

Answer:

There is no way to separately code for the splenic flexure mobilization in addition to the laparoscopic transverse loop colostomy. The take-down is included in the colostomy because it's a customary integral part of the procedure, especially for left-sided colostomies, which are more common.

If the physician documents that the take-down involves significant additional work, then you can append modifier 22 (Increased procedural services) to the procedure code, such as 44188 (Laparoscopy, surgical, colostomy or skin level cecostomy).

You are correct that you should limit the use of add-on code +44213 (Laparoscopy, surgical, mobilization [take-down] of splenic flexure performed in conjunction with partial colectomy [List separately in addition to primary procedure]) to primary procedure codes 44204-44208, meaning that you cannot report [...]